It May Not Be ADHD

Four medical problems that masquerade as this disorder

You probably know a lot of people—children and adults—who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). You are going to know even more in the years to come.

The Centers for Disease Control and Prevention reported earlier this year that nearly 20% of high school boys and 11% of all school-age children have been diagnosed with ADHD—an increase of more than 40% in the last decade alone. The numbers will continue to rise because recent changes in the definition of ADHD will cause more people to be diagnosed and treated.

Is there really an epidemic of ADHD? A more disturbing possibility is that millions of Americans have been given the wrong diagnosis, which means that they are not receiving the right ­treatment.

Symptoms in Search of a Disease

Think about most of the diseases that you know about, such as heart disease, diabetes or cancer. They have predictable symptoms. They can be reliably ­diagnosed by doing laboratory or ­imaging tests.

ADHD is different. There aren’t physical tests to identify it. It usually is diagnosed by a family physician who runs down a list of 18 possible symptoms. These include excessive talking, not listening and failing to pay close attention. A patient with any five of the 18 symptoms could be diagnosed with ADHD.

It’s a lowt hreshold for diagnosis, particularly because the symptoms are subjective. How much talking is excessive? Just how “close” is “close attention”? Does someone have an attention problem…or is he/she merely bored?

In the years between 2007 and 2012, sales of medications used to treat ADHD more than doubled. Most of these drugs are stimulants, such as ­ methylphenidate (Ritalin, Concerta) or forms of amphetamines (such as ­Adderall).

Stimulants do increase attention and reduce impulsive behavior, but they’re not always harmless. Side effects include appetite loss, sleep problems, weight loss and sometimes poor concentration and impaired memory. Patients who take them for a long time also tend to develop tolerance, which means that they have to take higher doses—and higher doses increase side effects.

What to Look For

Most people don’t realize that the symptoms of ADHD can be triggered by many different conditions.

Example: One of my patients struggled with concentration, organization skills, a short attention span, irritability and other symptoms that had been attributed to ADHD. It turned out that he actually suffered from bipolar disorder. His doctors missed the ­diagnosis because they assumed that he had ADHD.

Here, common causes of ADHD symptoms that are not ADHD…

Absence seizure. This type of seizure disorder doesn’t cause the dramatic symptoms that most people associate with seizures, such as writhing on the ground and eyes rolling back in the head. It’s much more subtle.

People with absence seizures often report brief episodes of blankness. They might not hear what someone’s saying. They sometimes see blackness in front of their eyes. They might seem distracted, as though they are staring into space. The episodes of “absence” typically last less than 20 seconds—and sometimes only one or two seconds.

One study found that 40% of children who had been diagnosed with seizure disorders met the diagnostic criteria for ADHD.

Seizures can be detected with an EEG, which shows characteristic brain patterns. This type of seizure often is treated with an anticonvulsant medication.

Sleep disorders. A sleepless night makes it difficult to be attentive the next day. The symptoms are worse when poor sleep is an ongoing issue. It could be due to sleep apnea (disturbances in breathing during sleep), insomnia or simply the habit of staying up too late.

A University of Pennsylvania study measured how well people performed with different amounts of sleep. Over a two-week period, those who slept eight hours a night had the best performance. Those who slept only four hours did the worst. Those in the middle, the six-hour sleepers, did worse than you would expect. They had attention lapses and did poorly on memory tests and other tests.

If your doctor doesn’t ask about your sleep habits, bring it up yourself. Be honest. What time do you really go to bed? How much sleep do you get? Your doctor might decide to test for sleep disorders, but there’s a good chance that you simply have poor sleep hygiene—going to bed too late, watching TV in the bedroom, etc.

Hearing/vision problems. Believe it or not, many children who have been diagnosed with ADHD simply can’t see or hear what’s going on around them. Studies have shown that people with ­vision problems are more likely to develop cognitive or behavioral issues, including poor mental focus.

Example: Suppose a student can’t see what’s on the blackboard. While other students are engaged with the lesson, he/she will be bored and fidgety. This can lead to a misdiagnosis of ADHD.

A study published by the Children’s Vision Information Network estimated that about 20% of schoolchildren have vision problems that make it difficult for them to concentrate in school.

Problems with hearing can cause distraction and poor focus. Even minimal hearing loss can cause an increase in behavior problems, according to ­research.

Children should get their hearing and vision tested once a year…adults can do it every few years.

Substance abuse. It is an uncomfortable topic for everyone, particularly parents, but it is very common in the US—and is among the main causes of ADHD-like symptoms.

Up to 25% of adults with substance-abuse problems meet the criteria for ADHD. Even modest amounts of alcohol, for example, can impair attention and focus, and people who drink more may have trouble with impulsivity and concentration.

Any form of substance abuse—such as marijuana, alcohol or cocaine—can cause problems. Unfortunately, up to 90% of users don’t seek treatment, possibly because they fail to make the connection between substance abuse and their symptoms.

My advice: Get help for substance abuse if you find yourself craving alcohol or other drugs…you have developed a tolerance to the drug’s effects…you are finding yourself in risky situations…or notice changes in your social or professional life.

print

Source: Richard Saul, MD, a behavioral neurologist and director of The Diagnostic & Developmental Center in Northbrook, Illinois. He is past-chairman of the department of pediatrics at Highland Park Hospital and a member of the American Academy of Pediatrics, American Academy of Neurology and Society for Behavior and Development. He is author of ADHD Does Not Exist (HarperWave). DDCDrSaul.comDate: June 1, 2014
Publication: Bottom Line Personal

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It May Not Be ADHD

Four medical problems that masquerade as this disorder

You probably know a lot of people—children and adults—who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). You are going to know even more in the years to come.

The Centers for Disease Control and Prevention reported earlier this year that nearly 20% of high school boys and 11% of all school-age children have been diagnosed with ADHD—an increase of more than 40% in the last decade alone. The numbers will continue to rise because recent changes in the definition of ADHD will cause more people to be diagnosed and treated.

Is there really an epidemic of ADHD? A more disturbing possibility is that millions of Americans have been given the wrong diagnosis, which means that they are not receiving the right ­treatment.

Symptoms in Search of a Disease

Think about most of the diseases that you know about, such as heart disease, diabetes or cancer. They have predictable symptoms. They can be reliably ­diagnosed by doing laboratory or ­imaging tests.

ADHD is different. There aren’t physical tests to identify it. It usually is diagnosed by a family physician who runs down a list of 18 possible symptoms. These include excessive talking, not listening and failing to pay close attention. A patient with any five of the 18 symptoms could be diagnosed with ADHD.

It’s a lowt hreshold for diagnosis, particularly because the symptoms are subjective. How much talking is excessive? Just how “close” is “close attention”? Does someone have an attention problem…or is he/she merely bored?

In the years between 2007 and 2012, sales of medications used to treat ADHD more than doubled. Most of these drugs are stimulants, such as ­ methylphenidate (Ritalin, Concerta) or forms of amphetamines (such as ­Adderall).

Stimulants do increase attention and reduce impulsive behavior, but they’re not always harmless. Side effects include appetite loss, sleep problems, weight loss and sometimes poor concentration and impaired memory. Patients who take them for a long time also tend to develop tolerance, which means that they have to take higher doses—and higher doses increase side effects.

What to Look For

Most people don’t realize that the symptoms of ADHD can be triggered by many different conditions.

Example: One of my patients struggled with concentration, organization skills, a short attention span, irritability and other symptoms that had been attributed to ADHD. It turned out that he actually suffered from bipolar disorder. His doctors missed the ­diagnosis because they assumed that he had ADHD.

Here, common causes of ADHD symptoms that are not ADHD…

Absence seizure. This type of seizure disorder doesn’t cause the dramatic symptoms that most people associate with seizures, such as writhing on the ground and eyes rolling back in the head. It’s much more subtle.

People with absence seizures often report brief episodes of blankness. They might not hear what someone’s saying. They sometimes see blackness in front of their eyes. They might seem distracted, as though they are staring into space. The episodes of “absence” typically last less than 20 seconds—and sometimes only one or two seconds.

One study found that 40% of children who had been diagnosed with seizure disorders met the diagnostic criteria for ADHD.

Seizures can be detected with an EEG, which shows characteristic brain patterns. This type of seizure often is treated with an anticonvulsant medication.

Sleep disorders. A sleepless night makes it difficult to be attentive the next day. The symptoms are worse when poor sleep is an ongoing issue. It could be due to sleep apnea (disturbances in breathing during sleep), insomnia or simply the habit of staying up too late.

A University of Pennsylvania study measured how well people performed with different amounts of sleep. Over a two-week period, those who slept eight hours a night had the best performance. Those who slept only four hours did the worst. Those in the middle, the six-hour sleepers, did worse than you would expect. They had attention lapses and did poorly on memory tests and other tests.

If your doctor doesn’t ask about your sleep habits, bring it up yourself. Be honest. What time do you really go to bed? How much sleep do you get? Your doctor might decide to test for sleep disorders, but there’s a good chance that you simply have poor sleep hygiene—going to bed too late, watching TV in the bedroom, etc.

Hearing/vision problems. Believe it or not, many children who have been diagnosed with ADHD simply can’t see or hear what’s going on around them. Studies have shown that people with ­vision problems are more likely to develop cognitive or behavioral issues, including poor mental focus.

Example: Suppose a student can’t see what’s on the blackboard. While other students are engaged with the lesson, he/she will be bored and fidgety. This can lead to a misdiagnosis of ADHD.

A study published by the Children’s Vision Information Network estimated that about 20% of schoolchildren have vision problems that make it difficult for them to concentrate in school.

Problems with hearing can cause distraction and poor focus. Even minimal hearing loss can cause an increase in behavior problems, according to ­research.

Children should get their hearing and vision tested once a year…adults can do it every few years.

Substance abuse. It is an uncomfortable topic for everyone, particularly parents, but it is very common in the US—and is among the main causes of ADHD-like symptoms.

Up to 25% of adults with substance-abuse problems meet the criteria for ADHD. Even modest amounts of alcohol, for example, can impair attention and focus, and people who drink more may have trouble with impulsivity and concentration.

Any form of substance abuse—such as marijuana, alcohol or cocaine—can cause problems. Unfortunately, up to 90% of users don’t seek treatment, possibly because they fail to make the connection between substance abuse and their symptoms.

My advice: Get help for substance abuse if you find yourself craving alcohol or other drugs…you have developed a tolerance to the drug’s effects…you are finding yourself in risky situations…or notice changes in your social or professional life.

print

Source: Richard Saul, MD, a behavioral neurologist and director of The Diagnostic & Developmental Center in Northbrook, Illinois. He is past-chairman of the department of pediatrics at Highland Park Hospital and a member of the American Academy of Pediatrics, American Academy of Neurology and Society for Behavior and Development. He is author of ADHD Does Not Exist (HarperWave). DDCDrSaul.comDate: June 1, 2014
Publication: Bottom Line Personal